Adhesions and Pelvic Pain

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Dr. Indman: I’m Dr. Paul Indman. We’re at the global congress of Minimally Invasive Surgery, and I have with me today a PhD researcher, Dr. David Wiseman from Dallas, Texas who is working on adhesions. You have an organization, ADHESIONS.org, can you tell me what that is all about?

Dr. Wiseman: Thank you Dr. Indman. We have an organization ADHESIONS.org, which has been going nearly ten years. Thanks to our good friends right here at OBGYN.net we have had a website running for almost ten years, and now it attracts over 100,000 visitors a month. We provide all kinds of resources and information for patients with adhesions that relate to disorders, and we have been able to, through the website, hook a number of patients up with other patients who are similarly affected, and that’s a tremendous help to them.

Secondly, we have been able to do all kinds of research, two papers of which we are presenting at this meeting. And thirdly, we are able to provide referrals for patients to doctors that have an understanding of their condition.

Dr. Indman: Now, could you share some of your recent research with us, simply?

Dr. Wiseman: Of the two papers that we are presenting here, the first one is regarding a description of the patients that have adhesions that relate to disorders. The literature is full of papers that describe the economic consequences of adhesions, how much it costs the system. But there is very, very little, if nothing, on what it’s like to have adhesions and the related conditions, from the point of view of the patient. So we set about to conduct a survey and those are the results we are presenting today. On our website we have patients on average that have had a diagnosis of adhesions for seven years. They have on average a bowel obstruction once a year. They’ve had about nine obstructions on average each. Their social support system is destroyed and compromised. They have gastrointestinal problems. They take drugs which make their gastrointestinal problems worse. But most interestingly, they have physical therapy some of them, and the physical therapy works in some of the cases. We have found some interesting things that we need to get the word out about.

Dr. Indman: Now that’s helpful. There is no question we all have seen patients that have severe objective disease, clearly adhesion related. On the other hand we see many women with no diagnosis who are told, “Oh you have adhesions, you have pain.” Or they may have some vague pain, you do a laparoscopy and you find a few adhesions. Well, I also know that there are studies that show if you take women in let’s say for infertility, and laparoscope them and rate the adhesions and rate the pain, many women with adhesions don’t have any pain. Do you think it’s fair just because someone has a few adhesions to say that’s the cause of the problem?

Dr. Wiseman: You are right. It’s not fair and I think that’s my big philosophical turnaround in the last few years. It has been known for a number of years that not all pain is caused by adhesions, and not all adhesions cause pain. Many of these women do come and they present, as you say, they have adhesions, no pain or the converse. I am beginning to think of the problem not just in terms of adhesions, but in terms of a more global set of symptoms because they may have adhesions, which may or may not have anything to do with their actual cause of pain, but they have an overlapping and coalescing set of symptoms. They have bowel problems, bladder problems, sometimes psychological problems, and these patients are sort of an amorphous group that needs to be treated holistically, rather than just saying, “Oh you have adhesions, let’s cut the adhesions out.” Or, “You have bladder problems, let’s address those bladder problems.” We have to look at them more holistically and so I am wondering whether we should not use the term “adhesions related disorder” anymore, we should use a more global term. The term I’ve used has a cute acronym and I’ve used it because no one else took the URL for it: CAPPS: Complex Abdominal Pelvic & Pain Syndrome. I’ve started a new website, ISCAPPS: International Society for Complex Abdominal Pelvic & Pain Syndrome, just to address the exact problem that you’ve outlined, and we didn’t even rehearse.

Dr. Indman: I’m going to go home and look at that immediately. Thank you very much Dr. Wiseman.

Dr. Wiseman: Thank you very much.